MSIA: Procurement responsibility

Written by Dr Geoffrey Sayer on 13 July 2011.

There is a desire by all parties involved in eHealth to ensure that eHealth delivers sustainable patient outcomes. Health commands considerable political attention so it is extremely important to ensure that money allocated to eHealth actually delivers sustainable patient outcomes. We don’t want to make it an easy target for allegations of wasteful spending. There is already enough of that. While many would argue the merits of a Personally Controlled Electronic Health Record (PCEHR), what is clear amongst those who have been around, are that eHealth foundation pieces and the original intention of the funding surrounding the PCEHR is movement in the right direction. It can be used as a binding goal if it is shared by a wide range of stake holders. The degree of binding though is limited when there is such a small scale approach to vendor inclusion in the process and the working around — almost against — industry.

When debating eHealth issues the MSIA has often been accused of being vendor centric. I find this quite an amusing criticism because as the Medical Software Industry Association we are supposed to be representing the views of the vendors. That is our job. It is an easy criticism to use to try and discredit the association as industry is in business. This criticism is often levelled at the association when the arguments we are making are not liked or understood. While there is an obligation for us to be clear and qualify the position we are taking, it is important that we play the issue and not the people. I cannot say that critics of industry have always had that philosophy. It is also apparent that industry has been the one calling for improvements to processes that are focused on improved clinical and patient safety. It has not always been government, who seem more concerned with political intent and positive press releases. In a time where the Government is merely one death, or resignation away from an election, the focus has been on positive spin, press releases — aspirations rather than actions.

When one looks at healthcare organisations it is assumed they are in the business of healthcare and are driven by principles and integrity. Given the considerable number of healthcare providers in this country (over 800,000) and the national healthcare expenditure of billions of dollars, one would expect there to be a large number of millionaires. There are not, excluding perhaps one or two corporate types who are several multipliers greater on paper than in actuality. People who have only ever worked in health or have spent decades in health are, by and large, not doing it for the money.

In the medical software industry, there is not a disproportionate number of millionaires — quite the opposite. Like other people who work in healthcare, most people who work in the software industry actually do it because they care about health. Many have worked as healthcare providers, healthcare administrators, healthcare educators or healthcare researchers and have blended their passion with skill and experiences in Information Technology (IT) and Information Management (IM). Many have been doing it for a long time because they are passionate about health and what IT and IM can do to improve health.

While public servants are accused of putting politics first and tax payers second, business is seen as putting profits or money first and customers second. Business lives and dies by being profitable it is argued. Some medical software businesses are able to sustain their business as they are part of a multinational company, are able to borrow money from banks, or are able to run very lean through the bad times while the hope for the good times. I don’t feel praying is an appropriate use of divine intervention for commercial activities. There are many other much worthy causes of omnipotent assistance. However, many of the medical software businesses in this country are running almost on empty. These companies have already invested and developed the capabilities that are now been sought through various tenders and PCEHR waves. There are many companies that have existing products and services that could be purchased through the considerable funding that has been made available through Wave 1 and Wave 2.

The rejection of 80 odd bids as part of Wave 2 is testament to the availability of existing capabilities and platforms that, with additional development, can deliver the requirements for the PCEHR program. These companies can do the job today. There’s no need to start from scratch. Yet procurers feel that when it comes to eHealth it is best to pay for a whole new product, and even provide considerable support for new companies. These companies have no current customers but are seen as more malleable to the procurer’s requirements. The development of a whole new platform is seen as the best option.

What is forgotten is that these new platforms and ventures have no credible form on the board for a national program. They do not have business infrastructure; service capabilities; application integration experience and scalability of delivering a fully integrated system. Procurers are not making use of the considerable experiences that existing players could bring to the PCEHR initiative.

It is best to consider when purchasing products and services the quality of the product and quality and longevity of the services that a company provides. It has to be about what represents value for money. This does not mean that one should not consider innovation and new players. There is however a need to look to protect the purchasing decision and tax payers dollars. There is even a greater responsibility when that purchasing decision is being made on behalf of tax payers. There are many people in the industry who have been outraged first as tax payers and have been outraged as vendors second.

There is a lot of argument that the evidence is not quite there for the effectiveness of IT and IM. The evidence though is continually mounting but the challenge is the changing pace of the IT and IM. Innovation is dynamic and things change — what is needed for tomorrow is not available today. Or is it? There are many companies whose experience and products meet the current demands, or could do so with only minor enhancements. It is odd that, rather than working with existing players, it seems that we want to work around them. We are seeing the selection and funding and development of unproven bolt-ons and work-arounds rather than sound, fully integrated solutions and sustainable support services from companies that have the pedigree and form on the board to deliver.

I have previously stated that taking short cuts will get you lost. Many of us have taken short cuts because we know where we want to go, but haven’t bothered to consider the details that it actually takes to get there. A top level view is not enough. Desire is not enough. It is a form of risk taking when short cuts are taken — not sure it will work but it is better than the longer way. The problem we create for ourselves is that we are trying to achieve too much in too shorter time. The current approach seems to have made a wrong turn and has forgotten that we want sustainable and scalable patient outcomes. Not press releases of work‑rounds that history tells us don’t deliver sustainable outcomes and most likely put clinicians and patients at risk. Caveat emptor — let the buyer beware.

As well as being President of MSIA, Geoffrey is Head of Operations, HealthLink. He has spent the past 20 years working as an epidemiologist. For the past 10 years Geoffrey has occupied senior management positions in medical software companies.